Mechanical Circulatory Support for the Failing Fontan: Conversion to Assisted Single Ventricle Circulation-Preliminary Observations

被引:7
|
作者
Peer, Syed M. [1 ,2 ]
Deatrick, Kristopher B. [1 ]
Johnson, Thomas J. [3 ]
Haft, Jonathan W. [1 ]
Pagani, Francis D. [1 ]
Ohye, Richard G. [1 ]
Bove, Edward L. [1 ]
Rojas-Pena, Alvaro [3 ]
Si, Ming-Sing [1 ]
机构
[1] Univ Michigan, Med Sch, Dept Cardiac Surg, Ann Arbor, MI 48109 USA
[2] Univ Minnesota, Dept Pediat Cardiac Surg, Minneapolis, MN USA
[3] Univ Michigan, Med Sch, ECMO Lab, Dept Surg,Sect Transplantat, Ann Arbor, MI 48109 USA
关键词
circulatory assist devices (LVAD; RVAD; BVAD; TAH); congenital heart disease (CHD); Fontan; CHD; univentricular heart; heart failure;
D O I
10.1177/2150135117733968
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background: Mechanical circulatory support (MCS) of a failing Fontan circulation remains challenging. We hypothesized that MCS can be provided by converting the Fontan circulation into a mechanically assisted single ventricle parallel circulation (MASVC). Methods: A porcine model of functionally univentricular circulation was created under cardiopulmonary bypass (CPB) by performing an atrial septectomy, tricuspid valvectomy, and interrupting antegrade pulmonary blood flow. A centrifugal flow pump was placed with inflow from the common atrium. Eight millimeter Dacron grafts anastomosed to the ascending aorta and main pulmonary artery supplied systemic (Qs) and pulmonary (Qp) blood flow. Ultrasonic flow probes were used to measure Qs and Qp after weaning from CPB. The Qp/Qs ratio was regulated using an adjustable clamp. Hemodynamic and laboratory data were recorded. Results: All four animals were successfully weaned from CPB onto the MASVC for a duration of two hours. Mechanically assisted single ventricle parallel circulation achieved satisfactory hemodynamics. As anticipated, the arterial oxygen saturation and partial pressure of oxygen in arterial blood were lower in the MASVC compared to baseline biventricular circulation. At the conclusion of the study, there was a trend towards a decrease in the mixed venous saturation with increasing oxygen extraction compared to the baseline. Serum lactate levels increased after weaning from CPB and did not return to baseline after two hours of support. Conclusion: Mechanically assisted single ventricle parallel circulation can be established in a single ventricle animal model. This strategy could potentially provide MCS of a single ventricle circulation. Studies with longer duration of support are required to assess adequacy of support and long-term sustainability.
引用
收藏
页码:31 / 37
页数:7
相关论文
共 32 条
  • [21] Mechanical Circulatory Support of a Univentricular Fontan Circulation with a Continuous Axial-Flow Pump in a Piglet Model
    Wei, Xufeng
    Sanchez, Pablo G.
    Liu, Yang
    Li, Tieluo
    Watkins, A. Claire
    Wu, Zhongjun J.
    Griffith, Bartley P.
    ASAIO JOURNAL, 2015, 61 (02) : 196 - 201
  • [22] The role of magnetic resonance imaging in the evaluation of the functionally single ventricle before and after conversion to the Fontan circulation
    Festa, Pierluigi
    Ali, Lamia Ait
    Bernabei, Massimo
    De Marchi, Daniele
    CARDIOLOGY IN THE YOUNG, 2005, 15 : 51 - 56
  • [23] Mechanical Circulatory Support as a Bridge to Transplantation in Children with Single Ventricle Physiology: A Multicenter Study
    Das, B. B.
    Kirklin, J.
    Pruitt, E.
    Chrisant, M.
    Lin, K.
    Hong, B.
    Daneman, S.
    Canter, C.
    JOURNAL OF HEART AND LUNG TRANSPLANTATION, 2016, 35 (04): : S46 - S47
  • [24] Indication for initiation of mechanical circulatory support impacts survival of infants with shunted single-ventricle circulation supported with extracorporeal membrane oxygenation
    Allan, Catherine K.
    Thiagarajan, Ravi R.
    del Nido, Pedro J.
    Roth, Stephen J.
    Almodovar, Melvin C.
    Laussen, Peter C.
    JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY, 2007, 133 (03): : 660 - 667
  • [25] Mechanical Circulatory Support for Failing Systemic Right Ventricle Using Left Ventricular Assist Device - An Option To Decide and Bridge?
    Peng, E.
    Griselli, M.
    O'Sullivan, J.
    Crossland, D.
    Chaudhari, M.
    Wrightson, N.
    Butt, T.
    Roysam, C.
    Parry, G.
    MacGowan, G. A.
    Schueler, S.
    Hasan, A.
    JOURNAL OF HEART AND LUNG TRANSPLANTATION, 2014, 33 (04): : S58 - S59
  • [26] Commentary: Mechanical circulatory support for the failing Glenn circulation: Keep all options on the table and don't give up
    Andersen, Nicholas D.
    Overbey, Douglas M.
    Turek, Joseph W.
    JTCVS TECHNIQUES, 2021, 6 : 149 - 150
  • [27] Another step toward successful mechanical support of neonatal patients with single-ventricle circulation
    Davies, Ryan R.
    JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY, 2018, 156 (04): : E175 - E176
  • [28] Mechanical Support as Failure Intervention in Patients with Cavopulmonary Shunts (MFICS): Rationale and Aims of a New Registry of Mechanical Circulatory Support in Single Ventricle Patients
    Rossano, Joseph W.
    Woods, Ronald K.
    Berger, Stuart
    Gaynor, J. William
    Ghanayem, Nancy
    Morales, David L. S.
    Ravishankar, Chitra
    Mitchell, Michael E.
    Shah, Tejas K.
    Mahr, Claudius
    Tweddell, James S.
    Adachi, Iki
    Zangwill, Steven
    Wearden, Peter D.
    Icenogle, Timothy B.
    Jaquiss, Robert D.
    Rychik, Jack
    CONGENITAL HEART DISEASE, 2013, 8 (03) : 182 - 186
  • [29] Outcomes of Mechanical Circulatory Support for Patients With Functionally Single-Ventricle Physiology at Different Stages of Surgical Palliation
    Saedi, Arezou
    Chetan, Devin
    Kotani, Yasuhiro
    Liyanage, Nishanthi
    Zhao, Lisa
    Caldarone, Christopher
    Van Arsdell, Glen
    Honjo, Osami
    CIRCULATION, 2013, 128 (22)
  • [30] An unexpected circular shunt: Novel method to treat semilunar valve insufficiency in a single ventricle patient on mechanical circulatory support
    Hagel, Jonathon A.
    Batlivala, Sarosh P.
    Morales, David L. S.
    Shahanavaz, Shabana
    CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, 2022, 100 (03) : 395 - 398